Provider Demographics
NPI:1346830957
Name:KNACK MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:KNACK MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-787-9700
Mailing Address - Street 1:10382 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-6801
Mailing Address - Country:US
Mailing Address - Phone:678-787-9700
Mailing Address - Fax:
Practice Address - Street 1:10382 FIELDCREST DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6801
Practice Address - Country:US
Practice Address - Phone:678-787-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)